Compliance with and dosing of angiotensin-converting-enzyme inhibitors before and after hospitalization

Compliance with and dosing of angiotensin-converting-enzyme (ACE) inhibitor s as they occur before and after hospitalization for heart failure were stu died, and factors predictive of compliance with and dosing of ACE inhibitor s after hospitalization were identified. Two hundred thirty-six patientd hospitalized with heart failure between Oct ober 1, 1995, and April 30, 1996, were identified. Compliance with and use and dosing of ACE inhibitors were examined over the 180-day period before a dmission and the 180-day period after discharge using an integrated pharmac y and medical claims database. Use of an ACE inhibitor was defined as at le ast one claim for an ACE inhibitor over the period examined, and dosing was assessed by calculating the mean percentage of an adequate daily dose disp ensed. Before hospitalization 109 patients (46.2%) used ACE inhibitors, and after hospitalization 148 (62.7%) used them-a significant increase . ACE inhibito r use before hospitalization was a predictor of postdischarge use. Younger patients were more likely to take ACE inhibitors after haspitalization than older ones, and men had better compliance after hospitalization than women . Additional analyses revealed that, among hospitalization patients, compli ance was lower in individuals who also took an antidepressant. Dosing incre ased from 72% to 85% of an adequate daily dose after hospitalization among patients who took ACE inhibitors during both prehospitalization and posthos pitalization periods. However, almost one third of hospitalized patients st opped taking their ACE inhibitor within six months of hospital discharge. The study found few significanlpredictors of patient compliance after hospi talizationl Dosing of ACE inhibitors before and after hospitalization needs to be improved.